Do video or telephone consultations impact attendance rates in an addiction medicine specialist outpatient clinic?

BACKGROUND: Effective alcohol and other drugs (AODs) treatment has been proven to increase productivity and reduce costs to the community. Telehealth has previously been proven effective at delivering AOD treatment in the right settings. Yet, Australia's current Medicare funding restricts telephone consultations. AIM: We hypothesise that treatment modality influences attendance rates. Specifically, telephone consultations can remove barriers to accessing treatment and, therefore, can increase attendance. METHODS: We conducted a retrospective audit on our addiction medicine specialist outpatient service from 1 July 2022 to 30 June 2023. A mixed-effects logistic regression model was used to analyse factors associated with attendance rates. RESULTS: There were 576 participants in the study, and 3354 appointments were booked over the 12-month study period. Of these, 2695 were face-to-face, 541 were telephone and 118 were video. The unadjusted raw attendance rate was highest in the telephone group (87.24%), followed by face-to-face (73.02%) and video (44.92%). After adjusting for covariates, telephone consultation was associated with significantly increased odds of attending compared to face-to-face (odds ratio (OR) = 2.60, 95% confidence interval (CI) = 1.90-3.54, P < 0.001). Video consultation was associated with a 69% reduction in the odds of attending compared to face-to-face (OR = 0.31, 95% CI = 0.019-0.49, P < 0.001). CONCLUSIONS: While physical attendance may be required for specific clinical care, telephone consultations are associated with increased attendance and can form an important adjunct to delivering addiction treatment. Given the substantial costs of substance use disorders, this could inform government policies and funding priorities to further improve access and treatment outcomes.

Serum ß-hCG levels post-treatment of ectopic pregnancy with a single dose of intramuscular methotrexate.

BACKGROUND: The cytotoxic management of ectopic pregnancy using a single dose of intramuscular methotrexate injection has been well established as effective for a select number of women with unruptured tubal ectopic pregnancy where there are minimal symptoms. AIM: The purpose of this study was to create centile curves of serum ß-hCG levels following successful treatment with a single dose of 50 mg/m(2) of intramuscular methotrexate to treat ectopic pregnancy. MATERIAL AND METHODS: Data were retrieved from women treated at the Royal Women's Hospital for ectopic pregnancy between 2006 and 2012. Only women with minimal symptoms, initial serum ß-hCG ≤5000 IU/L and ectopic mass size of ≤35 mm on ultrasound were included. Two hundred and fifty-three cases of ectopic pregnancy were analysed. RESULTS: Initial ß-hCG of women in the study ranged from 18 to 3995 IU/L with a median of 497 (25th to 75th centiles; 222-1160) IU/L. The median levels of ß-hCG levels at day 4, 7 and 14 postmethotrexate injection were 73.8, 47.2 and 10.4% of the initial ß-hCG level, respectively. The 90th centiles of ß-hCG levels at day 4, 7 and 14 were 124.7, 93.8 and 40.0% of initial ß-hCG level, respectively. CONCLUSIONS: Whilst no comparison with those unsuccessfully treated was made, pending further validation studies, the use of these curves may reduce the reliance on specialist units and streamline care for many women with ectopic pregnancy, such as those whose ß-hCG regress in line with centile values without crossing a certain threshold.

Long-term impact of radial artery harvest on forearm function and symptoms: a comparison with leg vein.

OBJECTIVE: The radial artery (RA) has gained popularity as a conduit for coronary artery bypass surgery despite a paucity of patient-centered analysis of long-term quality of life after its removal. We sought to characterize forearm function and symptoms after RA harvest and compare these with those associated with saphenous vein (SV) removal. METHODS: A total of 408 patients from an RA trial completed a questionnaire up to 14 years after primary coronary artery bypass surgery. The survey included 7 statements concerning hand and forearm symptoms or limitations in daily life and 4 questions on concerns associated with arm or leg scars. A total of 230 patients had received an RA graft (RA group). Responses were graded in order of severity from 0 to 7, with greater than 3 (mild concern) being regarded as a significant symptom. Mean response to each question and total scores were compared with the non-RA harvest group. Comparisons were also made with responses to the same questionnaire completed preoperatively and 3 months postoperatively. In patients who had both RA and SV removal, we compared the impact of a forearm scar on quality of life with that of a leg scar. RESULTS: The mean duration of follow-up was 9.3 years (range, 4-14 years), and the response rate was 83%. In the RA group, 92% to 99% reported no significant symptoms, with the most frequent concerns relating to pain and numbness (8% each), but this was not significantly higher than in those who had not had an RA harvested. In the RA group, the mean scores for scar appearance and discomfort were 0.95 and 0.93, respectively (where 1 = no concern), suggesting satisfactory cosmesis and no impact on function. Symptom severity was significantly worse in 6 of 7 questions when compared with preoperative responses and in 4 of 7 items compared with 3-month follow-up, indicating a general deterioration in function over long-term follow-up. In those who had both the RA and SV harvested, patients reported more scar discomfort associated with SV harvest at 3 months (1.69 vs 1.34, P < .001) and in the present questionnaire (1.21 vs 0.97, P = .002). Concerns with scar appearance were no different between the arm and leg. CONCLUSIONS: RA harvesting is associated with high patient satisfaction and less scar discomfort than SV removal. Overall, functionality declines with time, and a small proportion of patients seem to experience forearm pain and numbness. However, this is not different than in those without artery removal and may therefore be unrelated to the effects of surgery.

Choice of conduit for the right coronary system: 8-year analysis of Radial Artery Patency and Clinical Outcomes trial.

BACKGROUND: Previous reports have supported the use of bilateral internal thoracic arteries to revascularize the left coronary circulation. If this becomes standardized practice, the optimal conduit for the right coronary system remains to be established. Our objective is to compare the performance of the radial artery versus the saphenous vein when used to graft the right coronary artery or its branches during an 8-year period after primary coronary artery bypass graft surgery. METHODS: The Radial Artery Patency and Clinical Outcomes study is a randomized controlled trial comparing radial artery, saphenous vein, and free right internal thoracic artery. Of the 621 patients enrolled in the study, 465 patients received a graft to the right coronary artery or its branches. The retrospectively compiled database was used to establish patency rates and clinical events among these patients. RESULTS: Absolute graft patency rates were as follows: radial artery, 86.9% of 68 (95% confidence interval, 76.6% to 93.1%); and saphenous vein, 81.2% of 197 (95% confidence interval, 75.1% to 86.1%). Noninferiority tests show that absolute radial patency to saphenous patency is at least 0.9526 (p = 0.025). Kaplan-Meier estimates of angiographic outcomes show no significant difference (log rank p = 0.22). Cardiac events in the right coronary territory occurred in the radial artery group (1.79%) versus the saphenous vein group (4.93%; p = 0.26). Overall mortality was 8.03% in the radial artery group versus 12.5% in the saphenous vein group (p = 0.23). CONCLUSIONS: The radial artery patency is at least comparable to that of the saphenous vein when grafted to the right coronary artery or its branches. The paucity of clinical events in both grafts is notable. Selection of best conduit may therefore be made according to other factors.

Treatment of mandibular fractures in the 1980s.

Treatment of 317 mandibular fracture patients between 1981 and 1990 at the Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Oulu and Oulu University Hospital were analysed on the basis of patient files and radiographs. The patients had suffered altogether 452 mandibular fractures, most in the condylar region. The treatment was operative in 24% of cases and conservative in 76%. Operative treatment was commoner in edentulous than in partially edentulous or dentate patients. The proportion of operatively treated mandibular fractures increased toward the end of the period. The type of osteosynthesis also changed over the decade as wire and plate osteosynthesis gave way to compression plating and then to titanium miniplate and screw fixation of fractures. The advantages and disadvantages of the treatment methods are discussed and some typical cases using various modern fixation techniques are presented.

Mandibular fractures in northern Finland in the 1980s--a 10-year study.

A total of 317 mandibular fracture patients treated and diagnosed at the Oulu University Hospital and at the Department of Oral and Maxillofacial Surgery, University of Oulu, Finland, between 1981 and 1990 were analyzed from patient files and radiographs. The mean number of mandibular fracture patients per year was 31.7 (range 21 and 45) and the mean age of the patients 31.3 years (range 4-78 years). The female:male ratio was 1:3.1. There seemed to be a tendency for decrease in the proportion of violence and traffic accidents as causes of mandibular fractures toward the end of the period concerned, reflecting partly the influence of mandatory use of safety belts and partly that the hospital in the northernmost part of Finland, where the consumption of alcohol is higher than in the province of Oulu, could treat all mandibular fractures itself during the last year studied thus decreasing the injuries caused by violence at the Oulu University Hospital. It was also noted that fewer fractures were caused at weekends than on weekdays during the latter years of the decade and that the proportion of male victims decreased except for the last year examined, 1990.

Frequency and type of dental traumas in mandibular body and condyle fractures.

Dental injuries in association with 207 mandibular fractures were evaluated from patient files and radiographs. It was shown that 32% of the dentulous patients with condylar fractures had dental injuries, approximately 3.7 traumatised teeth per patient, most of which were dental hard tissue injuries and situated typically in the maxillary molar region. Dental injuries were diagnosed in 30% in association with mandibular corpus fractures, approximately 3.6 traumatised teeth per patient, and injuries were more often dental luxations in the anterior part of the mandible. It was found that 143 teeth were involved in the line of mandibular corpus fracture of 105 patients (1.4 per patient). More than half of the fracture lines were diagnosed as passing the periodontal ligament.

Frequency of alcohol-associated mandibular fractures in northern Finland in the 1980s.

In order to evaluate the frequency of alcohol-associated mandibular fractures, information on patients treated and diagnosed at a University Hospital and Dental Institute in northern Finland between 1981 and 1990 was analysed. Altogether, 117 male patients (out of 239) and 23 female patients (out of 78) were under the influence of alcohol at the time of accident. The annual risk for men receiving a mandibular fracture under the influence of alcohol (odds ratio) varied between 0.6 and 6.6, compared with female patients. More alcohol-associated mandibular fractures occurred in late summer and autumn and fewer in spring. Patients suffering mandibular fractures at weekends were more often under the influence of alcohol than those injured on weekdays. There seemed to be a tendency for the proportion of alcohol-associated mandibular fractures to decrease towards the end of the decade.

Use of percutaneous transluminal coronary angioplasty: results of a current survey.

To evaluate the current use of percutaneous transluminal coronary angioplasty (PTCA) in the treatment of coronary artery disease, 50 operators experienced in angioplasty (mean experience 949 +/- 706 cases) were surveyed. Although the use of angioplasty is still skewed toward less extensive disease (80% of 1-, 64% of 2- and 39% of 3-vessel disease), it is now estimated that 39 +/- 16% of patients undergoing diagnostic angiography are ultimately referred for PTCA, whereas only 28 +/- 13% are referred to bypass surgery. PTCA thus accounts for 58% of revascularization. Although approximately half of current PTCA patients are clinical candidates for bypass surgery, much of the growth of angioplasty has consisted of treating patients who are either too high a risk for bypass, or who have symptoms with medical therapy that are too mild to warrant surgery. Whereas elective procedures for stable angina (60 +/- 18%) are still the predominant indication for PTCA, a substantial fraction of procedures are performed for unstable angina (27 +/- 10%) or for acute myocardial infarction (13 +/- 15%). Despite a 91% current success rate, 9% of cases are unsuccessful, including 3% in which emergency bypass surgery is required. The most common reasons for unsuccessful procedures are failure to cross the lesion with a wire or balloon (52%), failure to dilate the lesion (4%), and abrupt closure of the dilated segment (44%) due predominantly to extensive local dissection. These data, based on a pooled experience of some 46,000 PTCA procedures, offer a unique glimpse into the current expanded application of this technique.